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Panminerva Medica 2002 March;44(1):73-5

language: English

Delayed ANCA positivity in pulmonary-renal syndrome

Nocente R., Gentiloni Silveri N. *, Bertazzoni G., Ceccanti M. **, Zannoni G. F. ***, Manna R. *, Gasbarrini G. *

From the Emergency Department, University “La Sapienza”, Rome, Italy
*Institute of Internal Medicine, Catholic University, Rome, Italy
**Institute of Sixth Medical Clinic, University “La Sapienza”, Rome, Italy
***Department of Pathology, Catholic University, Rome, Italy


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A 57-year-old man was admitted due to rapidly progressive renal failure and pulmonary edema. Chest X-ray showed a bilateral lung infiltrate, while a normal myocardial contractility was reported by echocardiography. Though initially ANCA were absent, a necrotizing vasculitis with polymorphonuclear leukocyte infiltrate was observed in a kidney biopsy specimen. Renal histology was compatible with microscopic polyangiitis because of necrotizing lesions located at small vessels and at glomeruli that were not crescentic. Corticosteroids and immunosuppressive treatment was played with significant clinical improvement. Six months later, the patient died of a gastrointestinal hemorrhage due to bowel perforation by vasculitic lesion. This time high p-ANCA positivity was detected and at renal histology crescentic glomeruli were observed.

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